Breast Abscess Drainage

Description
General or local anesthetic +/− IV sedation is used. The aim is to drain the pus
from the breast abscess cavity. Most small abscesses can be managed with percutaneous
aspiration and antibiotics. If symptoms have been present for weeks, the
patient is systemically ill, the abscess is very large, or drainage is incomplete, the

patient is probably best served by formal incision, and drainage. When the patient
is systemically unwell or considerable surrounding cellulitis is present, IV antibiotics
may be required. If lactating, the breast should be regularly expressed of milk
with a breast pump. The patient can usually still breastfeed using the contralateral
breast.
An incision is made directly over the abscess and drained of pus, irrigated and
a small drain placed, or left open, and the cavity packed if the abscess is large.
Healing often takes 1–2 months and cosmetic deformity is not uncommon.
Anatomical Points
Breast abscesses can occur in any area of the breast. If the abscess occurs at the
circumareolar edge, this condition may represent a periductal fi stula especially if
the patient is a smoker. The fi stula must be unroofed and curetted to allow healing.
Occasionally, infected sebaceous (epidermoid) cysts or areolar gland (of
Montgomery) cysts may be large and present as abscesses.
Perspective
The complications of breast abscess drainage include a chronic
healing wound, recurrent abscess, milk fi stula, periductal fi stula, systemic
infection, disfi guring scar, and breast deformity . If the wound is closed
over a drain or the skin closes too quickly in an open cavity, it is possible that
the abscess may recur. If it does repeat, incision and drainage are required. If
the abscess is large, the skin may need to be left open. Systemic infection is
rare, except in the immunocompromised host. Appropriate antibiotics should
be selected to cover the most common organisms. Staphylococcus aureus and
streptococcal species are the most common organisms. Non-puerperal abscesses
are most likely to contain anaerobes. Antibiotics of choice include fl ucloxacillin,
cepahalosporins, clindamycin, or vancomycin. Vancomycin is the preferred
antibiotic for penicillin-allergic pregnant women. Milk fi stula may occur in a
lactating patient. As long as the patient continues to breastfeed, the fi stula may
be slow to heal.
Major Complications
Systemic infection is the most serious complication of breast abscess. Fortunately,
it is very rare. When the abscess is evacuated, the pus should be sent for culture and
sensitivity. Antibiotic therapy should be tailored to treat the offending organism.
Scarring and skin dimpling with cosmetic deformity are common complications
that can be minimized by keeping the skin incisions as small as possible and closing
the skin when possible.